No abstract

There is currently no widespread strategy for treating medication-related osteonecrosis of the jaw (MRONJ), so our aim was to evaluate retrospectively the outcome of a minimally invasive treatment protocol for patients with both MRONJ and cancer. We designed a retrospective cohort study of patients with cancer who had been diagnosed with MRONJ after treatment with denosumab or bisphosphonates given intravenously. Primary outcome measures were improvement in the clinical stage of MRONJ and the time course to its resolution. Secondary outcome measures included the incidence of risk factors and patterns of treatment. Seventy-nine patients with 109 lesions were enrolled, and their characteristics, presentation of the lesions, complications, and relations to previous oral interventions were recorded. Treatment depended on the stage of disease, and included conservative medical, and minimally-invasive surgical, procedures. There was complete healing and resolution of disease in 38/57 stage 1 lesions, 30/47 stage 2 lesions, and 3/5 stage 3 lesions. The symptoms improved in 16/47 stage 2 lesions, and 2/5 stage 3 lesions. Fifteen of the stage 1 lesions, and one of the stage 2 lesions, failed to respond. Despite the possibility of an aggressive approach to the treatment of MRONJ, conservative treatment remains the first line of defence as regression is obvious, with evidence of no evolution to a higher stage. In our experience surgical intervention is recommended in persistent stage 3 MRONJ that has failed to respond to conservative treatment.

Abstract. Primary intraosseous squamous cell carcinoma (PIOSCC) derived from a odontogenic cyst is a rare form of odontogenic carcinoma. The incidence of carcinomas arising from odontogenic cysts is particularly uncommon and is reported to occur in 1-2 individuals for every 1,000 cases. The present case describes a 25-year-old man who was initially diagnosed with a chronically infected odontogenic cyst of the mandible. Biopsy and subsequent histology revealed the presence of squamous cell carcinoma. Therefore, neck dissection and hemimandibulectomy were performed. Ultimately, the situation in the mouth healed, though with a severe amount of scarring. Although the development of PIOSCC from an odontogenic cyst is rare, it should be included in the differential diagnosis for jaw bone radiolucency.

Introduction: The aim was to determine the efficacy of an extraction policy designed to prevent osteoradionecrosis (ORN) in dentate areas of the jaw after intensity-modulated radiotherapy (IMRT). A secondary aim was to establish whether our extraction policy risked unnecessary tooth extractions for areas designated to be not-at-risk of ORN. Methodology: Data were retrospectively collected from 100 oral cancer patients, including the fate of 1430 individual teeth, from diagnosis to follow-up. Results: Eight percent of IMRT-treated patients developed ORN; spontaneous cases (5) outnumbered those provoked by dental issues (3). All cases of ORN arose in regions irradiated with > 60 Gy, with the posterior mandible as preferred location, with nonspontaneous cases primarily due to progressive periodontitis. No correlation was found between the likelihood of extraction and cancer stage. Conclusions: A more robust extraction policy of teeth affected with periodontitis and pocket depths of 4-5 mm might be advocated in molar areas predicted to receive > 60 Gy. Unfortunately, our study's retrospective design precluded any detailed analyses of the underlying reasons for the 88 extractions that occurred at lower radiation dose thresholds; a more conservative approach may therefore be warranted for these low-risk areas.

ZusammenfassungBakterielle zoonotische Erreger sind häufig Auslöser von Erkrankungen mit teilweise schweren Verläufen. Sie sind wechselseitig zwischen Tieren (sowohl Wild- als auch Haustieren) und Menschen übertragbar. Die Transmissionswege sind sehr variabel, so kann die Übertragung u. a. durch orale Aufnahme über Lebensmittel, respiratorische Aufnahme über Tröpfchen und Aerosole sowie über Vektoren wie Zeckenstiche oder Nagerkontakte stattfinden. In diesem Zusammenhang sind auch das Auftreten und die Verbreitung von antibiotikaresistenten bakteriellen Erregern von zunehmender Bedeutung für den öffentlichen Gesundheitsschutz.Die Ausbreitung zoonotischer Erreger wird aktuell durch zahlreiche Faktoren verstärkt. Dazu gehören die Zunahme des internationalen Warenverkehrs, die Einengung der Lebensräume von Tieren und der dadurch zunehmend engere Kontakt zwischen Menschen und Wildtieren. Aber auch eine veränderte Tierhaltung in der Landwirtschaft und Klimaveränderungen können zur Ausbreitung beitragen. Der öffentliche Gesundheitsschutz und die Erforschung von Zoonosen sind deshalb von besonderer krankheitspräventiver, aber auch gesellschaftlicher, politischer und wirtschaftlicher Bedeutung.Ziel dieses Übersichtsartikels ist es, anhand von Beispielen die Spannbreite von Infektionskrankheiten darzustellen, die durch bakterielle zoonotische Erreger ausgelöst werden. Die unterschiedlichen Transmissionswege, epidemischen Potenziale und epidemiologischen Maßzahlen der beispielhaft gewählten Krankheiten sind Herausforderungen für den öffentlichen Gesundheitsdienst, den Tiergesundheitsdienst und die Lebensmittelüberwachung, deren Aufgabe es ist, die Bevölkerung vor diesen Infektionskrankheiten zu schützen.